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ICYMI: Top 25 Women in Healthcare: Tejal Gandhi

By | October 23 rd,  2015 | Lucien Leape Institute, Modern Healthcare, patient safety, Blog, boards, Brigham and Women's Hospital, CEO, chief quality and safety officer, National Patient Safety Foundation, Partners Healthcare, safety, Tejal Gandhi MD MPH CPPS, quality, Top 25 Women in Healthcare | Add A Comment


Classic content from 2015: One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.


The patient-safety movement has made slow and steady progress in the U.S. healthcare industry. But to achieve a faster pace of change, Tejal Gandhi, MD, MPH, CPPS, says change needs to come from the top of each organization – and that means above the CEO.


“We talk about CEOs and leadership in terms of patient safety, but I think the involvement of governance and boards is a major gap we’re overlooking,” says Gandhi, president and CEO of the National Patient Safety Foundation. “Most boards don’t know much about quality and safety. They tend to leave that to the clinicians and aren’t necessarily demanding better performance in this area.”


The move away from fee-for-service payment in healthcare makes this even more critical, she adds.


“If you start to pay for value, part of the value is quality and safety,” Gandhi says. “Boards are going to have to become more knowledgeable, and they will; they are smart people and will ask the right questions. Workplace safety is a big issue in every industry. The directors will need to demand more and even think about CEO incentives being tied to safety and quality.”


Gandhi, who served as chief quality and safety officer at Partners Healthcare and executive director of safety and quality at Brigham and Women’s Hospital before joining NPSF, believes most healthcare CEOs want to improve safety but get overwhelmed about where and how to begin.


“I think CEOs want to create the right culture – they know a culture of safety is important – but how to actually do it is where the challenge is.”


One key element of NPSF is its respected think tank, the Lucian Leape Institute, named after the Harvard physician and researcher regarded as one of the pioneers of the patient-safety movement. At the institute’s retreat last February, Gandhi said the leaders came to the conclusion that they needed to sharpen their focus on helping healthcare CEOs.


“For the last five years, we’ve been focusing on what we call the transforming concepts, the big issues that we need to see change to really make advancements in safety – issues like patient engagement, transparency and reforming medical education,” she says.


“At the retreat, we asked, ‘Where are we struggling, and what theme ran across all five of the reports we released on the major issues?’ The theme was culture.”


Back when the seminal “To Err Is Human” report on medical harm was published in 1999, little was written about culture in the healthcare environment. Today, notes Gandhi, culture can be measured and stakeholders sometimes insist that organizations do just that. Going forward, the Leape Institute plans to get down to brass tacks to help CEOs create safer systems.


“We can’t just say, ‘Go change your culture,’ ” Gandhi says. “We need to give people things that are much more tactical. And I come from an operational, tactical background so I like the fact that we’re going to create a playbook that says, ‘Here are the concrete steps you can take as a CEO to start down this path.’ ”


As a relatively young CEO who has been on the job for two years, Gandhi has great empathy for leaders. She says her own learning curve was steep and that getting up to speed on issues ranging from finance to human resources to even real estate “was like drinking through a fire hose for the first six months. There’s a different level of stress when you’re the leader, so that’s taken some time to get used to. But what makes this job fun is the learning.”


Key to any discussion of quality and safety in a healthcare setting are the doctors, and Gandhi, a board-certified internist, worked in clinical care for many years.


She is hopeful that the transition to value-based care will allow mid-level providers to participate more in patient care and allow physicians to get back to having significant conversations with their patients. Primary care physicians, she said, sometimes have a tough time even visiting their patients in the hospital because they’re seeing an overwhelming number of patients in clinic on any given day.


“The primary care physician is the person who can advocate for the goals and values of the patient when interfacing with the rest of the healthcare system,” she says. “I’ve seen payment models where the primary care doctor gets reimbursed for going to the hospital and seeing a patient. It’s very important.”


While patients can and should partner with physicians on decision-making and with organizations by being welcomed onto quality improvement committees, Gandhi says the predominant responsibility for patient safety should be with the caregivers.


“The whole ‘ask-me-if-I-washed-my-hands’ thing drives me a little crazy because the patient shouldn’t have to ask – that’s on us,” she says. “But we do need their advocacy, making sure patients feel comfortable asking questions, that they agree with and understand their plan of care and that their voice is part of creating that plan.”



Maureen Bisognano looks beyond the healthcare silo for improvement

By | October 16 th,  2015 | Healthcare, Triple Aim, hospitals, IHI, Maureen Bisognano, Modern Healthcare, Blog, CEO, Institute for Healthcare Improvement, leadership, MOOC, safety, upstream, quality, Top 25 Women in Healthcare | Add A Comment


One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.


For the last 20 years, it’s been common for healthcare executives to look to the aviation industry for both inspiration and best practices in improving quality and safety. But Maureen Bisognano, CEO of the Institute for Healthcare Improvement, thinks perhaps we should look beyond the horizon for the next step.


“Twice this year, IHI has led a study tour down to NASA,” says Bisognano, who is retiring at the end of the year. “When you walk into NASA, there is a wall that tracks the journey of a space shuttle from when it comes onto the launch pad until it returns safely back home.”


That board also tracks every near-miss, equipment failure, employee injury and fatality that has happened across the shuttle program. And when teams see that wall, that gets them thinking about the depth of the details in such transparency.


“Nobody in healthcare understands safety that way,” she says. “If we make an analogy to healthcare, the left side of the map might answer questions like: Have we safely admitted patients into the hospital? Do we understand everything about that patient’s care and life outside the hospital, and have we brought that knowledge to the people who will be caring for that patient in the hospital?”


The other side of the board, Bisognano says, could provide responses to the question, “Have we safely guided this patient back into the community with access to medications, food and care?”
Looking at healthcare issues from a different angle is standard operating procedure at the IHI, which can usually be found on the cutting edge of health innovation. And, while it is true that the healthcare industry is adjusting to some of the biggest changes in its history under the Affordable Care Act, it’s Bisognano’s belief that the current disruptions are small compared to what’s coming down the pike.


“I think leadership is in the midst of a transition,” she says. “Leaders are going to be out in the community in ways they never were before. They’re going to begin to understand what it’s like to live in a particular neighborhood –how can their hospital or physician practice or ACO create health in that environment? They’re going to be looking way outside the walls of the organization. I think they’re going to be challenged by managing multi-professional teams, because there is no way that healthcare can be provided by a specific discipline anymore.”


Those are bold words, but Bisognano says that scenario is the end result of what it means to move “upstream” into a community to deliver care, a concept that has been around for years but is gaining new urgency as hospitals and health systems seek to prevent readmissions. And data is the key to that, Bisognano notes.



“The notion of ‘upstreamism’ means that people are going to be engaging with data and technology in ways that they never did before,” she says. “We need roles like ‘upstreamists’ and ‘extensivists.’ Upstreamists are people who say, ‘I will look at all of the population health data, and I will help us to think about what kinds of interventions will have the greatest impact on health by looking way upstream.’ ”


In a new project called One Hundred Million Healthier Lives, Bisognano and the IHI are having the chance to put a grand notion like that into practice by partnering with community organizations as well as a number of healthcare providers across the country.


“As an example, I’m seeing in some communities that the upstream data is telling the healthcare system that the biggest impact it could have is to work on getting homeless veterans into permanent housing,” she says. “In another community, we’re looking at the healthcare system partnering with others to work on the health of children under 5, because the children of that community are not healthy right now.


“By ignoring that population, these children are going to experience a future 70 years of bad health and lots of unnecessary cost and burden on the healthcare system. But if we put our focus and attention on those kids, we’re hopefully buying them and the healthcare system 70 years of good health.”


IHI’s sphere of interest extends far beyond North America. Bisognano and the IHI have long studied other nations’ healthcare systems, and she is quick to note that U.S. healthcare providers can get quite an education from other nations.


“I have the great fortune to be in a position to work in different countries all over the world. I see opportunities for us to learn from other countries – some low- and middle-income countries – and certainly from countries like Sweden and Denmark,” she says. “With the speed of change needed here, leaders who can look up and look out will be able to incorporate new models, new ways of thinking in a way that gets to the Triple Aim much more quickly.”


The Triple Aim, of course, is one of the IHI’s signature initiatives – improving the patient experience, improving population health, and lowering healthcare costs. It has been adopted by numerous hospitals and health systems. Through its conferences, research and open school (265,000 students in 73 countries), the IHI has multiplied its influence over the past two decades. Now, it is partnering this fall with the Harvard TH Chan School of Public Health to offer a free massive open online course (MOOC) that Bisognano hopes will attract more than 30,000 physicians and nurses in the next year.


Through all of these channels, Bisognano hopes the IHI will play no small role in preparing next-generation leaders. “I’m so encouraged with the students who are learning improvement. They see improvement as just a way of life, so they don’t feel the frustration. They also don’t tend to get as burned out because, when they see a problem, they have the tools to improve it.”



At HealthPartners, Mary Brainerd's leadership approaches solutions from a nuanced angle

By | August 5 th,  2015 | Affordable Care Act, delivery, merger, payers, Triple Aim, financing, Modern Healthcare, organizations, ParkNicollet, providers, Blog, cancer, CEO, Head + Heart Together, Institute for Healthcare Improvement, leadership, Mary Brainerd, Northwest Alliance, safety, HealthPartners, quality, Top 25 Women in Healthcare | Add A Comment


One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.


While HealthPartners CEO Mary Brainerd is pleased that more people now have insurance through the Affordable Care Act, you’ll have to excuse her if she’s a little frustrated with how the law has had a rocky start in Minnesota, where innovations that already existed were scuttled by Obamacare.


For example, Minnesota residents who had pre-existing conditions already had insurance coverage through a special high-risk pool that included businesses as well as individuals. It had been functioning just fine for 30 years. The ACA shut the program down. Those individuals were forced to buy insurance products on the clunky exchange and now, in Year 2, are facing rate hikes of more than 50 percent because the risk pool is too small.


“That’s a federal issue, and we wish it would change,” Brainerd says. “But it appears no one has the political will at the federal level to ask, ‘What’s not working, and how can we help make it better?’ The more you segment the market when people have serious health conditions, the higher the costs are both for these individuals and for these smaller funding pools that are responsible for covering their costs.”


It’s an intriguing patient-centric perspective on Brainerd’s part, and comes from an angle that’s a little different than the typical healthcare-industry party line. But perhaps that’s to be expected from a respected executive with a degree in philosophy (as well as an MBA).


“I think there are actually a lot of areas in which both philosophy specifically and liberal arts in general add value, and that is that you spend time studying many different perspectives on the same topic,” she says. “So when you’re faced with challenges and decisions, you’re less likely to think there’s a formulaic right answer. Instead, you’re more likely to think there are many perspectives on this issue to explore and understand before moving to quick decisions.”


A 2013 merger with the ParkNicollet system was significant for HealthPartners because it doubled the organization’s patient base to more than 1 million and expanded the payer-and-provider capabilities that the company had been executing for 50 years. Other healthcare organizations are now jumping into the payer-provider mix, and Brainerd has some advice for them.


“I think the challenge for organizations that are just creating those capabilities is not to think of them as two separate businesses but instead to look at them as very integrated, synergistic businesses that have the same strategy. We have the same strategic plan for our delivery system as we do for our health plan, and it’s focused on people as our chief resource and asset.”


Yet the enormity of merging two large organizations was a challenge.


“There are 23,000 people making decisions across our organization every minute of every day, and so what we do and how we do it has to come from that shared sense of value and a common sense of purpose,” Brainerd says.


As the vehicle for that mission, HealthPartners’ culture is known as “Head + Heart, Together.” Internally, it has helped build cohesion. Externally, it has encouraged the organization get in front of the trend toward collaboration. For example, HealthPartners, Allina Health and a physicians’ group were all thinking about building an MRI center in one region of the Twin Cities metroplex. Instead, they worked together and built one center that they all utilize.


HealthPartners and Allina also joined forces in an initiative called the Northwest Alliance, with a view to achieving Triple Aim results in quality and health improvement, especially in urgent care and mental health services.


“Neither of us alone would have been able to bring that capability to the community,” she says.


The results, she says, have been so strong that HealthPartners and Allina are planning to extend the original 7-year agreement before it even expires.


Brainerd is equally committed to HealthPartners’ ties with the Institute for Healthcare Improvement, making, as in the case with the Northwest Alliance, the Triple Aim its overarching view of care. The Triple Aim’s focus on quality and safety is an area in which her personal experience has shaped her.


More than a decade ago, she was a patient in her own system as she dealt with breast cancer. Her care was excellent, but there were some less-than-stellar interactions with the system that made her re-evaluate what HealthPartners’ patients experience.


“I think anyone I know who has worked in healthcare and then has encountered the healthcare system as a patient, either themselves or a close family member, is changed by that experience,” she says. “Still, to this day, I almost viscerally recall that feeling of vulnerability that you have, and also the understanding that the physical challenges of treatments and surgeries is in many respects not even half the challenge of the emotional and psychological impact of a serious illness.


“It was a life-changing experience for me, and I hope it made me a better leader for our organization.”


While Brainerd says she believes the healthcare industry had made significant progress in safety, she also wonders what other blind spots exist.


“If, 10 years ago, we didn’t see those issues in patient safety, what are the things we’re not seeing today that future leaders will reference and say, ‘Why weren’t they focused on that?,’ ” she says. “For example, in our aim to minimize pain, we’re actually creating an environment where there are many worse health consequences as the result of the abuse, misuse and overuse of narcotics. More than 80 percent of the world’s narcotics are prescribed in the United States. And then I wonder what tomorrow’s example will be. I want to look for it.”



Innovation keeps George Brown, Legacy ahead of the curve

By | October 20 th,  2014 | Furst Group, Top 25 Minority Executives in Healthcare, executive, Modern Healthcare, Blog, CEO, diversity, George Brown, healthcare reform, leadership, Legacy Health, physician executive, safety, Walter Reed, physician leadership, quality | 1 Comments


One in a series of profiles of Modern Healthcare’s Top 25 Minority Executives in Healthcare (sponsored by Furst Group)


George Brown, the CEO of Legacy Health System in Portland, Ore., has had a long and distinguished career as a physician and leader, but his talents in innovation help him keep his organization on the industry’s leading edge.


From collaboration and affordable care to medical homes and information technology, Brown and his team have been unafraid to adapt and take risks, providing an example to the northwest region and the country at large.
Legacy joined with a number of organizations to form an integrated delivery system, Health Share of Oregon. It’s partnering on the OHSU Knight-Legacy HealthCancer Collaborative. In an era bursting with mergers and acquisitions, the path Brown has charted is intriguing.


“I have accepted the need to change from a completely competitive mindset to a collaborative mindset,” he says. “Competition doesn’t help the economics of healthcare – it divides communities.”


The Affordable Care Act has prompted soul-searching on the part of many executives, and Brown applauds the arrival of reform.


“I believe healthcare is too large of an issue for this country not to have a thoughtful and near-universal solution,” he says. “The Affordable Care Act is a step in the right direction.”


Although Brown has a sterling history in healthcare, it’s clear he doesn’t waste time looking back. He is especially proud to be on the board of Cover Oregon, despite some of the hits that the exchange took in the media for its early problems.


“We’ve enrolled 400,000 people,” he says. “We are moving in the direction to have affordable healthcare for all Oregonians.”


The ACA, he says, mirrors some of the measures Legacy has already been working on for some time, foremost of which is quality.


“The number one project we have been working on is how to make our organization more efficient,” he says, “and what we’re driving efficiency to mean is quality. We believe if you do things right, you don’t have to do them all over again, and that means it’s also less expensive.”


Brown also has led Legacy as an early adopter of the patient-centered medical home, an area in which some other health systems are just getting started.


“It’s important for me to say that all of our primary care clinics are Tier 3 certified patient-centered medical homes, and they’re doing very well,” he says. “Patient satisfaction scores are going up and we think we’re making an impact. In fact, we were recently recognized by the Oregon Health Leadership Council as being one of the top performers, so we’re quite proud of that.”


It’s also been a learning experience, Brown says candidly. He says Legacy has three main takeaways from the experience thus far:


--Specialization is needed. “If you have a population that’s heavy with patients who have congestive heart failure, diabetes, hypertension and obesity, a lot of contact is required with patients.”


--The influx of Medicaid patients changes preconceived notions for providers and patients alike. “There are a significant number of people who have not had access to healthcare services. We are evaluating those people and their needs. Some of these people have never seen us before, so that’s going to be an area of revelation for us.”


--Mental health is a gaping need in the community. “We’re realizing that behavioral health, mental health and addiction issues are a lot more prevalent in the population than I think we realized, so we’re looking at how best to provide access to those services for our patients who are in medical homes.”


Legacy also earned kudos via a Stage 7 award from HIMSS last year. Brown has long been a proponent of how technology can improve care.


“I think the lesson we’ve learned – and we have to remind ourselves so we don’t get to learn it again – is that a lot of IT projects really are not IT projects. They are clinical projects that require IT expertise,” he says.
“If you get the clinicians involved early they can become champions of the initiative, where before there may have been some naysayers. It’s important to listen to the clinicians, particularly in their early experience and exposure with products, so that you can modify and incorporate those things that they think are essential.”


Listening to the clinicians, Brown adds, “has been the key element of our success.”


It surely helps that cause that Brown is a physician himself, a gastroenterologist and internist who rose to the rank of brigadier general in the U.S. Army and led several military healthcare installations, including Walter Reed Health Care System in Washington, D.C.


At one time, he found little interest among his colleagues for administrative work. Now, under reform, that has changed as clinicians see their input as essential to changing the industry.


“I think the old attitude of some of my colleagues was, ‘I just want to be a physician. I don’t want to be bothered with running an organization.’ Now, clinicians are more involved. They realize they need to help shape the future of healthcare if they want to see things change in a way that’s commensurate with their beliefs. You shouldn’t be passive about change.”


Working hard to achieve change, he says, is an attitude he inherited from his parents, who saw him become the first family member to graduate high school and were unwavering in their support of Brown and his two siblings, seeing education as the door to opportunity.


“They would tell me, ‘You have the ability. If you apply yourself, you’ll be able to achieve whatever you want.’ “


It’s a lesson he’s applying at Legacy, facing the future with resolve.


Nursing roots important to Judith Persichilli as she leads one of the largest U.S. health systems

By | August 14 th,  2013 | Catholic, C-suite, Catholic Health East, clinical process, faith-based, health system, hospital, Lean In, Modern Healthcare, nurses, president, Sisters of Mercy, Blog, CEO, healthcare reform, leadership, nursing, safety, work-life balance, quality, Top 25 Women in Healthcare, Trinity | Add A Comment


One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)


“When I wake up in the morning and look in the mirror, I see a nurse. I don’t necessarily see a healthcare executive.”


Those words don’t belong, say, to the CNO of a small Midwest hospital. They’re coming from Judith Persichilli, who serves as interim president and CEO of Trinity/Catholic Health East, one of the largest health systems in the country. (Prior to the merger of Trinity and Catholic Health East, Persichilli was president and CEO of CHE.)


Nursing, Persichilli says, “has always been in my heart. It still is.” In fact, there is no shortage of executives on Modern Healthcare’s list of the Top 25 Women in Healthcare who have a background in nursing, including Persichilli.


Why do many nurses become successful healthcare executives? Persichilli says she thinks she knows.


“The education of nurses prepares them to be leaders,” she says. “You’re educated across the continuum; you understand the clinical process. You need strong relationship and communication skills as you’re dealing with physicians and other allied health professionals to promote a plan of care. At the same time, you are responsible in many instances for the communication with the family and significant others of the patient.”


While Persichilli leads an organization with $12.8 billion in operating revenue, she says healthcare workers at any level can make a significant difference in safety and quality in an era in which cost has become a driving concern.


“With healthcare reform, I truly believe that people with clinical knowledge – including, of course, physicians – have the skills to make the right decisions about the clinical process of care and actually lower the cost of care overall. They will make the right decisions about where patients can safely be taken care of with the highest quality.”


The merger of CHE and Trinity created a huge, national Catholic health system. Previously, some other Catholic systems merged with secular counterparts, but Persichilli said that doesn’t mean they’ve abandoned their faith-based roots.


“The other systems that have merged may organize themselves differently, but they still have a faith orientation within their organization,” she says. “We have decided, based on the heritage and the tradition of the women religious who sponsored the healthcare entities that formed into a system, that our system would be Catholic. That doesn’t mean we won’t be welcoming to secular relationships that share our vision and values.”


In fact, prior to the merger, Persichilli was part of a team at CHE that made the difficult decision to sell Sisters of Mercy Hospital in Pittsburgh to the University of Pittsburgh Medical Center system. The move enabled CHE to create a foundation that enabled the sisters to continue their work with the homeless, a population that depended on the faith-based care in the community.


“One of the Trinity CHE values is courage, taking risks,” she explains. “Our founding congregations came to this country with 50 cents in their pockets to take care of people. Mercy was an excellent hospital, but UPMC was so large. The situation gave us an opportunity to say, what are the unmet needs? How can we continue this ministry that was started more than 100 years ago by the Sisters of Mercy?”


Persichilli says she believes similar crossroads are in the future of many communities.


“I think we’re going to be making more of these decisions in healthcare as you look at the community needs assessments that are required under healthcare reform.”


Reform, she adds, resonates with the work that faith-based systems have been doing for years.


“That’s who we are in Catholic healthcare. It’s not just CHE and Trinity – that’s who we are. Sometimes it means saying, there’s enough acute care. How can we creatively develop the structures and the financial foundation to meet the unmet need? It definitely pulls us into environments that perhaps other people don’t want to go into – the homeless, the vulnerable.”


While it’s a well-known fact that the U.S. spends more than any other country on healthcare with less than stellar results, Persichilli says the belt-tightening prevalent in the industry doesn’t have to make quality decline at all.
“I spent three weeks with Catholic Relief Services in Uganda visiting AIDS clinics and looking at their ‘hospitals,’ ” she says. “And I came back to the United States with the understanding that, even in a time of constraint, we live in an era of abundance. We have to figure out how to tap that strength, to do things better at a higher quality and a lower cost.”


One idea on how to do that? Better communication.


“We can do it. It’s there. It will take people in the provider sector and the payer sector to talk to one another, not past one another.”


Persichilli says industry executives need to know their numbers, but also understand that healthcare goes beyond costs.
“No matter what, you need to know that you’re doing really important work. You have the privilege of taking part in and changing people’s lives. When I was a nurse, I used to say, ‘Let’s all stand together and ask the question: ‘What difference did you make in the lives of your patients today?’ ”


That kind of attitude is especially important to people at the beginning of their healthcare careers, she adds.


“Once you bring meaning to your work,” she explains, “you go about it with such commitment and passion that it’s hard not to be recognized. And once you’re recognized, you’re appreciated. Once you’re appreciated, you’re promoted. And once you’re promoted – if you bring that same passion and commitment forward – you will reach an executive level.”


Persichilli mentors a number of young female executives, but says she doesn’t get sucked into the “Lean In” debate.


“Work-life balance transcends gender when it comes to these executive positions,” she says. “I don’t ever step into somebody’s life and say, ‘You should do this or that.’ I always tell younger women, ‘It has to feel comfortable for you.’ And if it doesn’t feel comfortable for you and your career is going to be stalled as a result, understand the choices you make and be happy that at least you can make them.”


Today, she notes, stress about family isn’t confined to children – it could just as easily be about caring for one’s parents as part of the “sandwich generation.”


“If it’s too stressful and the children or your parents are not being taken care of the way you want, it’s not going to do anyone any good at work or at home. So understand who you are and what’s important to you. I don’t have any children, but I can tell you there’s nothing more important than raising good kids.


“I don’t have the answers here. I just know that, if you’re uncomfortable, own it and figure it out.”


A devastating injury failed to derail Karen Daley’s remarkable career

By | August 2 nd,  2013 | prevention, women executives, C-suite, Karen Daley, medical devices, Medicare, Modern Healthcare, nurses, nursing shortage, president, sharps, Baby Boomers, Blog, injury, leadership, nursing, patient care, safety, safety needles, American Nurses Association, Top 25 Women in Healthcare | Add A Comment


One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)


Karen Daley loved being a nurse, and she was a good one. But all that changed one day in 1998 when she was stuck by a needle while treating a patient. From that one needle stick, she contracted HIV and hepatitis C.


Her clinical nursing days were over. Over the next couple of years, she would undergo exhausting treatment regimens. But she was determined that the incident would not end her healthcare career.


“I learned how resilient I was physically and emotionally,” says Daley today, now president of the American Nurses Association and one of the 2013 Top 25 Women in Healthcare as chosen by Modern Healthcare. “It was a grueling time. I was constantly worried about fatigue, falling and exposing others to my blood, and I had little appetite because of the drugs. I looked sick.”


Yet while she underwent treatment, she plunged into advocacy, petitioning the U.S. Congress to change laws to reduce the odds that other nurses would have to face what she was going through. The laws were eventually changed to mandate use of safety-engineered sharps devices that could prevent similar injuries. Now, more than a decade later, compliance isn’t where it could or should be.


“We had to educate the healthcare system that these injuries and associated bloodborne pathogen exposures were preventable,” Daley explains. “Not only were they losing workers to these injuries, they were risking the goodwill of workers who learned over time that these were injuries that should not have occurred.”


In hospitals, she says, “prevention often is not seen as a viable strategy because it often costs money on the front end versus money you may or may not have to pay on the back end.”


While more safety needles are on the market and in greater use, Daley says the price drop that was promised by the medical device industry for the costlier devices as market penetration increased has not occurred. She also says federal enforcement of OSHA requirements is now a priority issue because “we know there are employers who are still not compliant with the requirements under the law.”


Beyond the institutional level and despite evidence that the overall number of these injuries has declined since the law was enacted, Daley says operating rooms remain a very high-risk area because surgeons control the kits and sharps that are used in each procedure, and are often resistant to changing their instruments or sharps devices. That has to change, she says. “Everyone’s health and safety is at risk with these injuries. It really is about what’s right across the board for a safer work environment.”


And medical device companies haven’t stopped making conventional or less effective early-generation safety needles and devices , nor have hospitals stopped buying them, she laments. “Today, despite the fact that the technology has improved significantly, we have some of the same devices on the market as when the law was passed.”


In the process of advocating around this issue, she says she’s learned that change is never simple, and that it’s important to get all stakeholders to the table, even congressional leaders who are feeling pressure from constituents and lobbying groups.


“For any movement, persistence is necessary,” she says. “It’s seeing the change through. We are still not where we need to be on needlestick injury prevention, so the need for persistence is another lesson learned.”


That’s a lesson she’s taken to heart in her own life, where she has gone back to the classroom numerous times to earn advanced degrees. Beyond her bachelor’s degree in nursing, she has earned a master’s in public health from Boston University School of Public Health, and a master’s in science and a PhD in nursing from Boston College.


To keep up with technological advances, the growing complexity of the healthcare system and patient healthcare needs, and to help combat the shortage of providers in healthcare, nurses need more education, she says.


“We need to make sure we’re helping nurses go back to school to advance their education. It’s an expensive proposition and that investment doesn’t always get recouped when they go back into the workforce,” Daley adds. “We also need to continue to grow the number of advanced practice registered nurses to provide care that is not going to be met by primary-care physician workforce, just based on numbers and geography.”


But shortages of all kinds are facing the practice of nursing, Daley says. There is an impending shortage of nurses, of nursing faculty, of chief nursing officers, and nursing-school deans – due to age, experienced nurses are retiring in large numbers. But the lack of adequate numbers of qualified nursing faculty is particularly vexing, she says.


“The faculty shortage represents a huge barrier for educating enough nurses. In fact, over the past several years, we’ve turned away more than 70,000 qualified applicants from nursing programs each year in this country because we don’t have enough faculty or clinical sites to accommodate them.”


Taken together, those numbers mean Daley will often be headed back to Capitol Hill to ask for more government funding to help to ease the crunch, exacerbated by the prospect of 2 to 3 million Baby Boomers aging into Medicare every year for the foreseeable future.


“We have to make sure the supply of care providers meets the demand,” she adds. “That care is largely going to be nursing care. So we have to feed the pipeline, and I’m concerned when I see so much reticence in Congress around the budget regardless of the issue, that we might not be able to keep up with what is going to be a very unusual shortage and critical demand over the next decade.”


Part of the issue, she suggests, is a lack of understanding of the value the nursing profession brings to patient care.
“What has to happen,” she adds, “is nurses need to be better understood as not simply compassionate caregivers, but as knowledgeable and skilled providers who impact patient outcomes and are licensed and accountable as part of their societal contract to assure patients of safe, quality care.”


She notes the case of two nurses in Texas’ Winkler County who anonymously reported a physician for unsafe practices (their allegations were proven to be true). But a law-enforcement official who was friends with the doctor uncovered the nurses’ identities and they were fired, prosecuted and indicted. Though they were later vindicated and won a settlement, the entire episode gives other nurses pause about speaking up, Daley says.


She is no less candid in describing the state of women in the C-suite, noting the paucity of female leaders in healthcare. “If I were to characterize it in one sentence, I would say we’re not doing very well at all in shattering the glass ceiling. We need to make a lot of progress to raze that ceiling.”


Daley hopes she can play a small role in changing that view of the ceiling.


“As I go out and speak with nurses and other leaders around the country, my job is to inspire and empower them to find their own voice, and to encourage them to take the risks that are necessary for making change. I want to help them continue in their own journey to be effective change agents within a larger system.”


Undaunted by the setback that ended her nursing career, Daley is taking her own advice to heart.

Personal experiences add passion to Maureen Bisognano's drive for patient-centered care

By | July 18 th,  2013 | Triple Aim, IHI, Maureen Bisognano, Modern Healthcare, nurses, patient-centered, patient safety, president, Blog, board of directors, CEO, Institute for Healthcare Improvement, leadership, nursing, safety, quality, Top 25 Women in Healthcare | Add A Comment


One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)




Maureen Bisognano asks a lot of them. She asked many questions when she was a nurse, and when she ran a hospital. Now, she asks plenty as the President and CEO of the Institute for Healthcare Improvement, the renowned organization that helps the healthcare industry improve the quality and safety of care.


Leadership in these areas, Bisognano says, has to start at the top.


“Many boards and leadership teams still don’t understand the meaning of these quality measures, in cost terms, and in terms of the impact they have on patients,” she says. “Leaders get a quality report that is red, yellow or green -- self-defined colors that don’t tell them nearly what they need to know When I go to visit a board or a senior team, I ask them four questions to provoke them to think at a deeper level.”


Here are Bisognano’s four questions, with some of her comments for annotation:


**Do you know how good you are as an organization? “It’s knowing this qualitatively and quantitatively, not just in terms of red, yellow or green. Do you hear what patients are saying? Do you have patients at the board meetings? Not just patients who have been harmed, but ones who have had a great experience, because boards need to know where to reinforce quality as well as where to push for better quality.”


**Do you know where your variation is? “Boards and leaders mostly look at averages. So they don’t know if they’ve got some performers in their organization who are superstars and some who are really poor performers. By looking only at averages, they’re tolerating a level of bad performance that they wouldn’t if they better understood variation.”


**Do you know where you stand relative to the best? “Most leaders don’t know the answer to this. They look at their own data and they may not realize that there are other organizations in their state, in the country, or in the world that are doing dramatically different, dramatically better. And that provokes thinking.”


**Do you know your rate of improvement over time? “If you’re looking at static numbers, and thinking that they’re getting better, you may never know what the rate of improvement is. So I suggest to leaders that they always look at the rate of improvement over time.”


As the developers of the Triple Aim, IHI’s knowledge and unique culture encourage and nurture respect.
“At IHI, we are very much a team-based culture and our layout in Cambridge, Mass., reflects this,” Bisognano says. ”Everybody’s working throughout the course of a day on teams, so there’s constant challenge and learning and a great sense of camaraderie.”


Even Bisognano, the CEO, doesn’t have an office of her own.


“In my office, there are multiple workstations and a big table in the middle. So all day long, you’ll hear different conversations taking place. It’s very much a culture where, if you’re in the middle of something, you may need to stay focused on that. But if you’re interested in what your colleagues are talking about, you can turn around and contribute.”


Currently, Bisognano’s office has ten names listed outside its doors, representing a diverse mix of IHI senior executives, Fellows, and Senior Fellows, including the former chief executive of the National Health Service in England as well as the president of the National Academy of Medicine in Mexico.


Bisognano says IHI’s influence is felt in four concentric circles. Every 90 days, the members of the IHI R&D team select five to seven unsolved problems in healthcare to research in an attempt to generate solutions. That’s the inner innovation ring. The second circle is one focused on partnerships with organizations like Premier, Catholic Health Partners, Kaiser Permanente and the nation of Scotland to test out those solutions and demonstrate results.


The third circle is where IHI concentrates on equipping thousands of professionals with improvement skills and capabilities, using the educational vehicles of forums, seminars and webinars. The last, outer ring is all about dissemination, “getting the word out” on IHI’s website, via IHI’s online ”talk show,” WIHI, through blogs and social media, and by actively working with reporters on timely stories for a wide range of media outlets. Thus, the work begun by 130 people in IHI’s offices can reach millions.


“A lot of people know us by the Forum and by the Open School, but it’s a much more strategic and all-encompassing view when you look at us from the inside out,” she notes.


The focus on partnerships is critical, Bisognano says, because IHI wants to help equip healthcare providers with the tools they need to achieve optimal care. And to do that, the care needs to be patient-centered. That’s a mission and a journey that is very personal to Bisognano.


When she was in nursing school, Bisognano’s younger brother (she’s the oldest of nine children) was diagnosed with Hodgkin’s disease at a young age, a disease that ended his life.


“I watched healthcare provide what it could for him. But I also watched what it didn’t do for him, and that was to support him and our family facing this inevitable death,” she says.


She also grew in her own understanding, moving from a focus on what medicine could do, to what the patient wanted. She remembers vividly a day in a Boston academic medical center. The doctors had made their rounds as her brother Johnny grew weaker. One radiation oncologist, though, came back into the room.


“Johnny, what do you really want?” he asked.


“I want to go home,” he said.


The physician didn’t say a word. He came over to Maureen, took her jacket from her, and wrapped it around Johnny. Then he carried Johnny to Maureen’s car.


“I know that doctor broke every rule but he taught me an incredible lesson,” Bisognano says. “I thought my role was to give him encouragement and say, ‘Let’s try another round of chemotherapy.’ But my role was to ask him what he wanted. So when I got him home, I asked him what he wanted. He said, ‘I want to be 21.’ He died about five days after his 21st birthday. Those last few weeks were very meaningful, but very different. He was home, and we had all the family coming around to visit.”


She learned another lesson from Robbie, her sister’s son. Robbie was a perfectly healthy baby, but had a severe allergic reaction to a DPT shot at 2 months old that put him in the intensive care unit for a week. He recovered. At his 4-month exam, the doctor was about to give his 4-month DPT vaccine, when Bisognano’s sister stopped him.


“Don’t you remember what happened the last time?” she asked.


“No, what?” asked the physician.


She explained the reaction, the fear, the long hospitalization. The doctor paused for a moment, then said, “I don’t think the shot had anything to do with it, but I’ll only give him half a dose.”


The vaccine was administered. Robbie was dead within 24 hours.


Like Bisognano herself, her sister had questions.


“My sister asked me three questions,” she remembers. “Why were his records in the hospital separate from the records in the doctor’s office? How did the doctor not know that you don’t give even half a dose if there has been an allergic reaction? And, most importantly, why didn’t he listen to me?”


Those questions have driven Bisognano’s passion and guided her to this day.


“What happened to Robbie changed me. But my sister never sued. Most families who have experienced medical errors don’t sue. They’re looking for recognition and acknowledgment and apology more than anything else.”


One of the themes that Bisognano returns to is that healthcare is so complicated that a team approach is needed, and that one person can’t do it all.


She was with a group of residents recently who had come through a Lean training week.


“The first resident,” she says, “stood up to give his report and said, ‘I was blind to the mayhem. I would come in each morning, do my procedures, and I never saw all the other pieces of what was happening to these patients over the course of 24 hours, or over the course of a treatment diagnosis.’ ”


That light bulb moment is similar to what nurses experience continually, she says. The Top 25 Women in Healthcare include a lot of women who, like Bisognano, got their start in nursing; she believes this view of the sum of the parts is one reason so many nurses have made the transition to the corner office.


“Nurses are taught to see the whole health system, the whole journey of care, and we’re taught to see the family as part of the team,” she says. “I think that broad view of systems helps when you get to an executive level because you’re looking at how to put all the pieces together in a different and more effective way.”

Profiles in Leadership: Proctor puts priority on outcomes

By | August 30 th,  2011 | Healthcare, St. Joseph Health System, strategy, Top 25 Women, faith-based, hospital, Modern Healthcare, outcome, Blog, CEO, leadership, safety, culture, Deborah Proctor | Add A Comment

One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)


Outcome vs. strategy: which takes the lead?


Deborah Proctor, president and CEO of St. Joseph Health System in Orange, Calif., makes it clear where she stands on that age-old business dilemma.


“One of the things that I learned in my career is that most people will develop a strategy and then measure how well they’re accomplishing that strategy. To me, that’s an insufficient process,” she says. “I think you have to first determine what outcomes you’re trying to achieve and then develop strategies to get to those outcomes.


“But you keep measuring the outcome and you adapt the strategies if they’re not getting you to the outcome.”


Proctor’s belief in outcomes colored the strategic plan that she and her staff created in 2006, and she made sure it was tangible and accessible for all St. Joseph employees.


“Instead of sharing strategies like improving financial performance or aligning with physicians –which are certainly important – we focused on talking to employees about outcomes,” she says.


St. Joseph identified three goals “that every employee could relate to,” says Proctor:


**That the employees of our system would strive to provide perfect care.


**That the communities served by St. Joseph Health System and its hospitals would be among the healthiest in the nation.


**That every encounter with patients, community members, and one another would be a sacred encounter.


“Perfect care” sounds like an unattainable goal but, to Proctor, who began her career at St. Joseph Hospital in Orange, California as a registered nurse, it has to do with focus.


“Obviously that’s a very tough standard to live up to,” she admits. “But what are you going to say, that I want to give people the best care 90 percent of the time? I don’t think we can say the aim is anything less. Perfect care doesn’t mean perfect outcome, but it means that everything that’s within our control will be done exceptionally without errors.”


Proctor’s insistence on a culture of safety stems from her experience in another health system.


“We were having a strategic meeting and, in the middle of the meeting, one of the physicians got a phone call that informed him of an unnecessary death had occurred in one of our facilities,” she remembers. “From that time, it really became a focus area for me.”


To make it tangible, St. Joseph Health System set out to improve its record with ventilator-associated pneumonia, which was straggling behind more than 60 percent of other U.S. hospitals. In one year, it moved up to the top 10 percent in the country.


“Quality,” she says, “has always been given an equal standing with finance in terms of what executives are held accountable for on their goals.”


If Proctor sounds like a decisive executive, it’s because she is. But the faith element of her career is never far below the surface.


“My faith is a critical part of my life,” she says. “That ability to have coherence between my personal values and what I’m doing at work – to me, there’s nothing better because it’s so much more than a job.”


And St. Joseph Health System’s mission, “extending the healing ministry of Jesus in the tradition of the Sisters of St. Joseph,” is key to Proctor’s motivation.


“I use all my best business knowledge. But to me, working in a faith-based system is more fulfilling because I’m very clear about our mission and what we’re trying to accomplish – which then makes the business decisions have more relevance and meaning.”